Saturday, July 28, 2007

Could This Help To Explain Some Of the Racial Disparities in Heathcare?

I think this could be a contributing factor, but this does not deal with all of the disparities. This study only covers treatment once a patient is able to see a doctor. It doesn't deal with many of the other disparities impacting healthcare, such as access, cost of medicine, health insurance or lack thereof, economic status, etc.

The researchers seemed to go out of their way not to call this racism, but instead... an unintentional or "unconscious" bias. A 2005 study didn't try to use such sugar coated language, referring to the problem as entrenched unconcious racism. It may be true that most of this is unintentional...but I would say that it stems from an institutional racism of sorts, that planted the seeds in the minds of some of these doctors that trained them (perhaps unconsciously) to accept the idea that a Black life may not be as valuable as those of other races.

Regardless of what they call it... there is now more and more evidence that it is there... so they can't say it is being made up or is all in our heads. Many black folks don't need any convincing from a study... they have first hand experience with this two-track healthcare system. However, such studies are still useful in bringing the problem to the attention of the wider public.

Other reports and studies have pointed out numerous disparities in healthcare, but it was only within the last few years that these efforts have sparked a wider interest in the medical community.

As more studies come out, perhaps good public policy can now be developed to begin to deal with the problem.

Report below from United Press International

By ADRIANNE APPELUPI Correspondent

BOSTON, July 20 (UPI) -- Young doctors may harbor implicit racial biases, and this gets in the way of African-Americans receiving care equal to that of whites, a Harvard University study reported this week.

It has been well documented that there is a gap in the healthcare treatment African-Americans receive, especially in emergency rooms, according to the study authors.

A number of studies have shown that whites are twice as likely as blacks to receive full treatment for heart attacks in the emergency room, according to the study, available at the Web site of the Journal of General Internal Medicine.

The Harvard study and a handful of others in recent years are attempting to zero in on whether inherent racial bias on the part of the provider is a factor, and how this may play out, said Dana Carney, a postdoctoral fellow in the psychology department at Harvard.

The Harvard study examined the conscious and unconscious attitudes of 220 interns -- almost all of whom were white -- toward white and black patients.

The study found that most of the physicians, whether white, Asian or Latino, tended to harbor biases against black patients and that this resulted in the patients receiving less thorough treatment, Carney said.

Just six of the interns were black, and while they expressed less bias against black patients, in some, it was there, Carney said. The reason is broad stereotypes propagated by the media and society in general, she said.

"The problem is they can influence judgment and behavior in ways we don't want them to," Carney said.

In the study, 220 interns from four institutions in Atlanta and Boston took a computerized survey that asked them to show how they would treat a 50-year-old man who came into the emergency room with chest pain, a potential heart attack.

The interns were randomly assigned to either a black patient or a white patient.

The interns who were assigned to a black patient and who expressed unconscious bias against black patients tended to give them less care for a heart attack.

The more bias they expressed, the less treatment they would tend to give to the black patient.

Those interns who were biased against black patients would tend to give more treatment to white patients, the study found.

Further, the results found a tendency on the part of the interns to view black patients as uncooperative in general and in terms of agreeing to treatment recommendations.

The study checked for conscious bias against black patients by asking the interns to rank whether they preferred black or white patients and how much. Very few physicians expressed open bias against black patients.

Nelson Adams, the president-elect of the National Medical Association, which represents African-American physicians, said biases that result in less care for African-Americans is a problem that has serious consequences for the African-American community and the nation.

"It is my belief and the association's position that some of these biases are contributing to the continued gaps we see in the health status of citizens in this country. Though we know education is crucial in alleviating most ills, without adequate resources very little will take place," said Nelson, an obstetrician/gynecologist at Jackson North Hospital in Miami.

"The NMA has also been clear in stating that something ought to be done," he said.

Broad, systemic changes are needed to root out the bias that still exists in the United States against many groups, Nelson said.

"One thing that is crystal clear among the medical community is the whole notion of human beings being human beings. We have so much in common, the differences are minuscule," he said.

"We ought to be clearly aware that bias in healthcare occurs in providers but that it happens at all levels -- at the individual level, the provider level and the institutional level. All need to be addressed, and not just one," he said.

One factor that would help on a number of different levels is for medical schools to recruit more black students to become doctors. Last year there were just 100 black medical students in school, excluding those at historically black colleges, he said.

"We do have ways to make people less biased," John Dovidio, a Yale University psychologist, told UPI. High on the list are training and classes.

What would help in the physician community is a requirement that they receive such training after they leave medical school. Physicians are required to take a certain number of courses during their careers, usually focused on new treatments. They should also take courses on cultural sensitivity, communication and race, Dovidio said.

For example, studies show that communication needs to be improved between white physicians and black patients. Dovidio also believes that black patients bring their inherent biases and stereotypes with them as well.

"Whites have a very different impression of how the interaction went. Blacks tend to believe that it went less well. Whites tend to think it went well, and that blacks thought it went well," Dovidio said.

Still, it isn't as if the training is easy and that everyone is very open to the idea that they may hold unconscious biases, he said.

"People go into medicine because they are good people. If you try to bring the message that they aren't as good as they think, it's a hard message to bring," he said.

"These issues still don't get the kind of importance that a new drug or treatment would get. People aren't bad people, they are busy. The effects of bias are more subtle, more long term. Other issues are more immediate. This takes a back seat," Dovidio said.

3 comments:

Judy Falk Russell
said...

I also find the article soft-pedaling the discrepancies which indicate racism. My friend sent me your blog, and I would be happy to read of any further developments as a result of this study or any other articles about inherent white racism. I am trying to educate myself. Only 100 blacks in medical school outside of black colleges? SOMETHING must be done.

I'm an attending emergency physician. I would argue that data derived from surveys given to interns at only 4 facilities does not accuratly reflect bias in the way black patients with chest pain are treated. I would also argue that an intern (fresh graduate from medical school) is not experienced enough to comment on the appropriate risk stratification, treatment options, and patient disposition for any patient - regardless of their ethnic back ground

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